الفهرس 
Mycology and EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Invasive fungal infections are increasingly common in the nosocomial setting . Furthermore, because risk-factors for these infections continue to increase in frequency, it is likely that the incidence of nosocomial fungal infections will continue to increase in the coming decades. This expansion is based on an increase in the number of immunocompromised patients, including cancer patients with chemotherapy-induced neutropenia, transplant recipients receiving immunosuppressive therapy, and human immunodeficiency virus (HIV)-infected patients.
These infections are difficult to diagnose and cause high rates of morbidity and mortality, despite antifungal therapy. Early initiation of effective antifungal therapy and reversal of underlying host defects remain the cornerstones of treatment for nosocomial fungal infections. In recent years, new antifungal agents have become available, resulting in a change in the standard of care for many of these infections. Nevertheless, the mortality rate of nosocomial fungal infections remains high, and new the-rapeutic and preventive strategies are needed. Nowadays, there is a marked shift in the epidemiological profile of fungal infections; new and emerging pathogens such as Zygomycetes (e.g., Rhizopus and Mucor spp.), hyaline molds (e.g., Fusarium spp.), yeast-like fungi (e.g., Trichosporon spp.) and some dematiaceous fungi are increasingly being reported.
The host response to fungal pathogens is a complex and coordinated interaction among innate, adaptive, and complement effector arms and their associated soluble factors that combine to eliminate the pathogen and create long-lasting immunity against the fungal pathogen encountered.
Clinical diagnosis of fungal infections is problematic because clinical presentation is variable and non specific. For example, fever that is unresponsive to antibiotics, leukocytosis, chorioretinitis, endophtalmitis and skin lesions are common findings in fungal infections. Invasive disease (deep candidiasis) may affect major organs, such as the kidneys, spleen, liver, lungs, eyes, brain, and heart. Organ involvement can lead to organ failure if infection is not treated quickly and effectively.
The microbiological diagnosis of fungal infections can be obtained using traditional approaches, such as macro and microscopic examination, fungal cultures, and serological diagnosis, or newer, less established procedures, which include antibody detection and amplification of fungal nucleic acids.
Antifungal therapeutic strategies currently in use or under investigation include prophylaxis of high-risk patients and preemptive, empirical, and targeted therapies. Currently available agents include: Azoles (fluconazole, itraconazole, posaconazole and voriconazole), the echinocandins (caspofungin, micafungin, and anidulafungin), polyenes [conventional amphotericin B deoxycholate (DAMB), liposomal amphotericin B (LAMB), amphotericin B lipid complex (ABLC), and amphotericin B colloidal dispersion (ABCD)]. When selecting an antifungal agent, the intensivist must take into consideration properties, potential for toxicity, drug-drug interactions, and pharmacy acquisition cost.